Category Archives: Health Care

by James A. Bacon

Having expanded Medicaid coverage for more than 325,000 Virginians, Governor Ralph Northam now has issued an executive order directing actions to increase the number of Virginians enrolled in “quality, affordable health care coverage.” Secretary of Health and Human Resources Daniel Carey will explore ways to expand Medicaid enrollment, reduce insurance premiums, increase transparency of insurance choices, and develop a “data-driven strategy to create efficiencies in coverage and improve outcomes” with a special focus on “vulnerable” populations.

We won’t know what these initiatives will cost the non-vulnerable (the vast majority of Virginians) until we see the proposals. But as Carey undertakes his inquiries, he and the Governor would be well advised to remember how much health care in the form of Medicaid is already costing the state.

State General Fund spending on Medicaid services has increased from $2.29 billion in Fiscal 2010 to $4.88 billion in Fiscal 2019, according to a recent update on state spending by the Joint Legislative Audit and Review Commission. That was an annual growth rate of 9% yearly, and it accounted for 39% of the growth of all General Fund spending, crowding out other priorities.

Meanwhile, the Kaiser Family Foundation has found that the average cost of employer-provided family health care coverage now exceeds $20,000 a year, with workers paying slightly more than $6,000. That’s a 5% increase from last year — and it doesn’t take into account steadily rising deductibles and co-pays. Middle-class Virginia households are caught in a triple whammy — supporting ever-inflating Medicaid costs, paying more for their own insurance, and paying more out-of-pocket. Continue reading →

Palliative care grades by state. Source: released 2019 “State-by-State Report Card on Access to Palliative Care in our Nation’s Hospitals”

by James A. Bacon

There are many ways to gauge the quality and cost-effectiveness of Virginia’s hospitals. One is to measure cost and efficiency. Another is to track mortality rates and re-admissions. Yet another is to rate patient satisfaction. You can find these metrics on the Virginia Health Information website.

But health care is a phenomenally complex business, and many other aspects of hospital care are measurable. In a recent press release, the Virginia Hospital & Healthcare Association (VHHA) pointed out, for instance, that Virginia is one of 20 states (and Washington, D.C.) to earn an “A” for palliative care, based on a study by the Center to Advance Palliative Care and the National Palliative Care Research Center.

What is palliative care? It is, according to the report, “specialized medical care for people living with a serious illness. It is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage in a serious illness.”

Having witnessed the lingering deaths of a step mother and father-in-law in recent years, I get it. The goal should not be to prolong life at any cost but to improve the quality of life that remains. Continue reading →

Sentara Norfolk General Hospital: emergency room admissions up 7%

by James A. Bacon

More than 300,000 Virginians have something today they didn’t have last year — health insurance through Medicaid, observes Virginia Public Radio. What they don’t have is a primary care physician. Many are still seeking primary care treatment at hospital emergency rooms.

Admissions to the emergency room of Norfolk General Hospital have increased 7% this year. One hoped-for benefit of Medicaid expansion is that more patients would seek treatment outside the emergency room, one of the most expensive settings for medical treatment. Clearly, that benefit has not materialized. “There’s a whole behavior modification and teaching and education that needs to happen,” says Sentara Norfolk General President Carolyn Carpenter.

Yeah, that…. and there’s a Medicaid-patients-finding-a-doctor thing that needs to happen, too. Due to low reimbursement rates, many primary care physicians cap the number of Medicaid patients they treat.

One would think that Governor Ralph Northam, a physician, would appreciate this. But other than allowing more latitude for nurse practitioners to treat patients, I have seen no remedies proposed by Virginia’s ruling class to address the most significant of all barriers to health care. The inaction calls into question how serious people really are about expanding real health care coverage for the poor. Continue reading →